Catheter Ablation of Atrial Fibrillation Raises the Plasma Level of NGF-β Which Is Associated with Sympathetic Nerve Activity

Background/Introduction: Paroxysmal atrial fibrillation (PAF) is the most common arrhythmia and catheter ablation (CA) is selected with the aim of rhythm control. CA was reported to increase heart rate (HR), which explains the modulation on the cardiac autonomic nervous system. However, little is known about the relationship between heart rate, sympathetic nerve activity and parasympathetic nerve activity in patient with PAF. Purpose: The purpose of this study was to evaluate the effect of CA on direct recording of muscle sympathetic nerve activity (MSNA) and heart rate variability (HRV), and these influences on HR. Methods: This study was conducted as a prospective, observational study. Patients with PAF who were scheduled for CA were enrolled. We measured blood pressure, HR, body weight, brain natriuretic peptide (BNP), echocardiogram parameters, high frequency component as cardiac parasympathetic nerve activity and low frequency component as cardiac sympathetic nerve activity in HRV, and MSNA before and 12 weeks after CA. Results: 21 PAF patients participated in this study. After CA, E/e’ and Ln BNP were significantly reduced(10.6±2.9 to 9.2±2.6, p<0.05. 3.8±1.3 to 3.3±1.6 log/pg/ml, p<0.05, respectively) while no significant changes were observed in EF, SV, left atrial diameter, left ventricular end diastolic and systolic diameters. HR was significantly increased (61.3±7.8 to 71.1±7.6 beats/min, p<0.05, respectively). However, the MSNA burst incidence and frequency were significantly decreased (65.4±12.6 to 41.3±13.4 bursts/100beats, p<0.01, n=21. 39.8±8.8 to 28.1±9.6 bursts/min, p<0.01, n=21. respectively). Also, the reduction in MSNA burst frequency was correlated with the increase in HR (r=0.57, 95%CI 0.183-0.804, p=0.00702). Ln Low frequency component in HRV was significantly decreased (5.72±1.75 to 3.85±2.13 log/ms 2 , p<0.05, n=12), but Ln high frequency (HF) component was not changed . No significant relationship observed between increased HR and HF component. Conclusion: CA induced paradoxical increasing heart rate with the reduction in sympathetic nerve activity in patient with PAF. These findings suggest that CA might modulate autonomic interaction between sinus nodes and in left atrium with denervated in ganglionated plexi.

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Sympathetic responses induced by radiofrequency catheter ablation of atrial fibrillation

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00470.2018 ◽

2019 ◽

Vol 316 (3) ◽

pp. H476-H484 ◽

Cited By ~ 2

Author(s):

Jian Cui ◽

Mario D. Gonzalez ◽

Cheryl Blaha ◽

Ashley Hill ◽

Lawrence I. Sinoway

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrium ◽

Sympathetic Nerve ◽

Radiofrequency Catheter Ablation ◽

Sympathetic Nerve Activity ◽

Muscle Sympathetic Nerve Activity ◽

Parasympathetic Activity ◽

Nerve Activity ◽

Cardiac Parasympathetic Activity

Radiofrequency catheter ablation (RFCA) is a frequently performed procedure in patients with atrial fibrillation. Prior studies have shown that the RFCA may directly stimulate vagal afferents during the procedure, whereas the vagal tone assessed by heart rate variability (HRV) is lowered weeks after the RFCA procedure. The effects of RFCA performed in the left atrium on sympathetic nerve activity have not been assessed. In the present study, we hypothesized that RFCA would lower muscle sympathetic nerve activity (MSNA) during ablation and would raise MSNA 1 day postablation. A total of 18 patients were studied. In protocol 1 ( n = 10), electrocardiogram, blood pressure, and MSNA in the peroneal nerve were recorded through the RFCA procedure performed in the electrophysiology laboratory. In protocol 2, eight patients were studied before the procedure and 1 day postablation. RFCA led to a decrease in MSNA immediately after the procedure (25.4 ± 3.2 to 17.2 ± 3.8 bursts/min, P < 0.05). Cardiac parasympathetic activity was determined using indexes of HRV and increased during the procedure. One day postablation, MSNA was above baseline values (21.3 ± 3.7 to 35.7 ± 2.6 bursts/min, P < 0.05). HRV indexes of cardiac parasympathetic activity fell, and the HRV index of sympathovagal balance was not significantly altered. The results show that RFCA raised cardiac parasympathetic activity and decreased MSNA during the procedure. One day postablation, MSNA rose and cardiac parasympathetic activity fell. In addition, RFCA evokes differentiated sympathetic responses directed to the heart and skeletal muscles. NEW & NOTEWORTHY The effects of radiofrequency catheter ablation performed in the left atrium on muscle sympathetic nerve activity (MSNA) have not been assessed. The results of this study show that radiofrequency catheter ablation raised cardiac parasympathetic activity and decreased MSNA during the procedure. One day postablation, MSNA rose and cardiac parasympathetic activity fell. We speculate that the partial autonomic afferent denervation induces these effects on autonomic activity.

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Skin Sympathetic Nerve Activity and Rate Control of Atrial Fibrillation

Proceedings of IMPRS ◽

10.18060/22679 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Anthony Douglas II ◽

Takashi Kusayama, MD, PhD ◽

Peng Sheng Chen, M.D

Keyword(s):

Atrial Fibrillation ◽

Beta Blocker ◽

Rate Control ◽

Sympathetic Nerve ◽

Sympathetic Nerve Activity ◽

Ventricular Rate ◽

Strong Correlations ◽

Nerve Activity ◽

Blocker Therapy ◽

Beta Blocker Therapy

Background and Hypothesis Lifetime risks for atrial fibrillation (AF) are 1 in 4 for people 40 years of age and older. Rate and rhythm control are both important strategies in managing patients with AF. However, not all patients respond to beta blocker therapy. We hypothesize that sympathetic tone is important in rate control of AF, but the importance varied among patients. Experimental Design or Project Methods neuECG is a new noninvasive method to record skin sympathetic nerve activity (SKNA) and electrocardiogram. The present research recruited and recorded 2 paroxysmal and 3 persistent AF patients for 24 hours using neuECG. The average voltage of SKNA (aSKNA) and ventricular rate during AF was analyzed in one-min windows. Results The preliminary data reveal strong correlations (r=.783, r=.640, respectively, p<0.0001 for both) between aSKNA (1.19 ± 0.21 µV) and ventricular rate (110 ± 8 bpm) in the paroxysmal AF. High correlations were consistently observed when data were analyzed on an hourly basis. In comparison, strong correlations were found between aSKNA (1.13 ± 0.2 µV) and ventricular rate (88 ± 8.6 bpm) in persistent AF (r=.496, r= .796, r=.636 respectively, p<0.001 for both cases). However, hourly correlations displayed much higher variability between aSKNA and ventricular rate than that observed for paroxysmal AF. Conclusion and Potential Impact. aSKNA positively correlates with ventricular rate during AF. This relationship is stronger and more consistent during paroxysmal than persistent AF. These findings may be important in determining the efficacy of beta blocker therapy in rate control of AF.

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Abstract 16096: Successful Pulmonary Vein Isolation Improve Diastolic Dysfunction and Sympathetic Nerve Activity in Atrial Fibrillation Patients

Circulation ◽

10.1161/circ.142.suppl_3.16096 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Yusuke Mukai ◽

Hisayoshi Murai ◽

Tadayuki Hirai ◽

Takuto Hamaoka ◽

Yoshitaka Okabe ◽

...

Keyword(s):

Atrial Fibrillation ◽

Diastolic Dysfunction ◽

Sympathetic Nerve ◽

Sympathetic Nerve Activity ◽

Muscle Sympathetic Nerve Activity ◽

Left Ventricular ◽

High Rate ◽

Reverse Remodeling ◽

Nerve Activity ◽

Acceleration Rate

Introduction: Atrial fibrillation (AF) is associated with diastolic dysfunction (DD) at a high rate and the presence of left ventricular DD is also associated with increased muscle sympathetic nerve activity (MSNA). Catheter ablation (CA) of AF was reported to improve cardiac function, including the reverse remodeling of left ventricle and atrium. However, little is known about the effect of CA on MSNA and DD in AF patients. Purpose: The purpose of this study was to evaluate the effect of CA on MSNA and DD and the difference in therapeutic effect between two groups with and without DD. Methods: This study was conducted as a prospective, observational study. AF patients who were scheduled for CA were enrolled. The patients were divided into two groups, E/e’ ratio≧11 and <11. We measured blood pressure, HR, body weight, echocardiogram parameters, and MSNA before and 12 weeks after CA. Results: 28 AF patients participated in this study. After CA, in the patients with DD(the group of E/e’≧11, n=12), E/e’ ratio, the MSNA burst incidence(BI) and frequency(BF) were significantly decreased (13.4±2.1 to 10.6±3.0, p<0.01. 64.4±15.8 to 34.0±12.0 bursts/100beats, P<0.01, 39.7±9.3 to 23.5±9.2 bursts/min, p<0.01 respectively). In the patients without DD (the group of E/e’<11, n=16), the BI and BF were significantly decreased (59.7±11.8 to 43.5±11.7 bursts/100beats, P<0.01, 38.1±10.5 to 29.2±8.4 bursts/min, p<0.01 respectively) while there was no difference in E/e’ ratio. Interestingly, in the patients with DD, decrease in BI and BF were more pronounced compared in the patients without DD(-30.4±15.9 to -16.2±11.5 bursts/100beats, P<0.05. -16.3±11.5 to -8.9±13.8 bursts/min, P=0.145 respectively). In both groups, no significant changes were observed in EF and peak acceleration rate of mitral E velocity. Conclusion: CA reduced MSNA in AF patients. In the patients with DD, the reduction of MSNA tended to be more remarkable than without DD. These findings suggest that changes of MSNA might reflect the improvement of DD and reduction of AF burden.

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